Risk of Major Psychiatric Disorders Among Survivors of Childhood and Adolescent Cancers

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In a Taiwanese study reported in the Journal of Clinical Oncology, Hsu et al found that survivors of childhood and adolescent cancers were at a significantly increased risk of multiple major psychiatric disorders compared to those without cancer.

Study Details  

The study used data from a nationwide data set (National Health Insurance Research Database) on 5,121 survivors of eight organ system–related cancers matched 1:10 on demographic characteristics with 51,210 noncancer controls. Risks for seven disorders were evaluated: autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).

Key Findings

Mean age at cancer diagnosis was 9.1 years (standard deviation = 5.7 years). Median follow-up was 11 years.

Incidence of major psychiatric disorders among survivors was 14.26% for ADHD, 5.66% for MDD, 2.34% for ASD, 1.37% for BD, 1.17% for OCD, 0.78% for schizophrenia, and 0.59% for PTSD.

Survivors were at significantly increased risk of:

  • ASD (hazard ratio [HR] = 10.42, 95% confidence interval [CI] = 4.58–23.69)
  • ADHD (HR = 6.59, 95% CI = 4.91–8.86)
  • BD (HR = 2.93, 95% CI = 1.26–6.80)
  • MDD (HR = 1.88, 95% CI = 1.26–2.79)
  • OCD (HR = 3.37, 95% CI = 1.33–8.52)
  • PTSD (HR = 6.10, 95% CI = 1.46–25.54). 

Risk of schizophrenia was not significantly increased (HR = 1.87, 95% CI = 0.64–5.41).

Survivors were significantly younger vs controls at age of diagnosis of ADHD (mean = 8.3 vs 9.5 years, P = .028), schizophrenia (17.8 vs 20.6 years, P = .048), MDD (17.9 vs 20.1 years, P < .001), and OCD (15.3 vs 19.4 years, P = .011).

The risks of major psychiatric disorder diagnoses varied according to specific cancer types. Cancers significantly associated with the greatest number of individual disorders (four each) were brain cancer (ADHD, HR = 12.25; MDD, HR = 3.52; OCD, HR = 8.78; and PTSD, HR = 18.50) and lymphatic/hematopoietic cancers (ASD, HR = 9.00; ADHD, HR = 6.52; BD, HR = 4.84; and OCD, HR = 4.25).

The investigators concluded, “We found that childhood and adolescent cancer survivors were at higher risks of major psychiatric disorder diagnoses than controls. Follow-up care should include psychosocial interventions focusing on early signs of mental health problems and early interventions in this high-risk group.”

Mu-Hong Chen, MD, of the Department of Psychiatry, Taipei Veterans General Hospital, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology, Taiwan. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.